Simi Hills Home Care Center

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Martha Arroyo arrived at the facility unannounced for a required one-year annual inspection today at 8:00 a.m. The last annual conducted at this facility was on 09/01/2022. When the LPA arrived, there were two (2) staff and four (4) residents present. The LPA was greeted at the door by staff Eloisa Vasallo and the reason for the visit was explained. The Administrator, Lidia Medina arrived at 8:40 a.m. Entrance interview conducted. At 8:43 a.m., the LPA along with the Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. KITCHEN: The LPA inspected the kitchen/food service area at 8:50 p.m. Kitchen appliances appeared clean and were in operable condition at the time of the visit. The facility has a sufficient supply of perishable and non-perishable food. Food labels were inspected and checked for dates and expiration dates and food labels had expiration date clearly markedThe knives and sharps stored in a locked cabinet in the kitchen. Cleaning supplies and disinfectants are stored under the kitchen sink inaccessible to residents. COMMON AREAS: At the time of the visit, living room and dining room furniture was observed to be in good condition. The LPA observed two residents having breakfast in the dining room during the inspection. The facility maintained a comfortable temperature. At 9:07 a.m., smoke detector(s) and carbon monoxide detector were tested and operational at the time of the visit. The fire extinguishers were observed fully charged and last serviced on 3/15/2023. (Report Continued on LIC 809...) (Report Continued from LIC 809...) The LPA observed required postings throughout the common space. Different activities are offered to residents daily. LPA observed reading books, movies, and puzzles accessible to residents in care. GARAGE/BACKYARD: The washer and dryer are in the garage. The garage is kept locked at all times. There is an additional refrigerator in the garage. The facility has emergency food and water which was observed to be in good condition. Cleaning supplies and toxins were observed locked and inaccessible to residents in care. The facility has at least a 30-day supply of Personal Protection Equipment (PPE). The backyard has a covered outdoor area equipped with furniture for resident use. Emergency exits and passageways were observed free of obstruction. There is one gate that self-latches. No bodies of water noted at the time of the visit. BEDROOMS: There are four (4) resident bedrooms. The LPA observed the resident bedrooms to be furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. There is a staff room on premises. The LPA observed a closet in the hallway with extra towels and linens. RESTROOMS: There are two (2) resident restrooms. The first restroom is located in the hallway and the second restroom is located in bedroom #4. Restrooms were clean and sanitary and in operating condition with grab bars and non-skid surfaces. The bathrooms were sufficiently stocked with supplies and paper towels; towels and washcloths are not shared. The hot water temperature was measured in both bathrooms and measured between 105- and 120-degrees Fahrenheit at the time of the visit. RECORDS: Records review began at 9:21 a.m.; four (4) resident records were reviewed for, but not limited to: appraisals, medical records, admissions agreement, consent forms. At 10:27 a.m., record review of Resident #1’s (R1’s) file revealed R1’s Admissions Agreement was completed but missing R1’s signature. The Administrator will have R1’s Power of Attorney (POA) sign form. (Report Continued on LIC 809C...) (Report Continued from LIC 809C...) Personnel records were reviewed for, but not limited to: personnel records, health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All files were in order. The current Administrator’s file was also reviewed, and it was in order. At the time of the visit, the LPA obtained the following documents: LIC500 Personnel Report, LIC9020 Client Roster, the emergency disaster plan, and a copy of the liability insurance. MEDICATIONS: Medications review began at 12:55 p.m.; medications are centrally stored and locked in a cabinet inside the kitchen. All medications including PRNs were labeled, stored, and locked inaccessible to residents. PRNs have physicians order on file. Medications are labeled and checked for expiration dates. No errors observed during the medication review. The LPA conducted interviews with three staff during the inspection. Exit interview conducted. Report was reviewed and a copy was issued.the state’s words, verbatim · CDSS document, Oct 6, 2023

The state marks this report as 4 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Zabel Chochian arrived at the facility to conduct a Required Annual visit. This annual had a specific emphasis on infection control practices and procedures. Upon arrival LPA met with Administrator and explained the reason for the visit. INFECTION CONTROL: During today’s visit, the LPA spoke with the Administrator regarding the facility’s infection control practices. Upon entry, the facility has a central entry point for symptom screening, temperature checks, and sanitation station. The facility has an adequate supply of Personal Protection Equipment (PPE) and the facility can obtain additional supplies as needed. The facility’s cleaning protocol is sufficient. If needed, the facility has the capacity to designate a single isolation room if the facility has a confirmed case of COVID-19. The Administrator ensures that staff and residents are provided with updates regarding changing policies and procedures from the Department; including facility’s Mitigation and Infection Control Plan. The facility has not had a confirmed case of COVID-19 at this time; however, the facility’s policies and procedures as it pertains to infection control are adequate. Approximately 1pm, LPA and Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. KITCHEN: Knives and chemicals are stored inaccessible. The facility has a sufficient supply of perishable and non-perishable food. BEDROOMS: LPA observed the resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. RESTROOMS: Restrooms are clean and sanitary and in operating condition with grab bars and non-skid surfaces. LPA observed appropriate signage in the bathrooms promoting hand hygiene. COMMON SPACES: At the time of the visit, living room and dining room furniture was observed to be in good condition. The LPA observed the required postings on the bulletin board. In addition, the LPA observed postings throughout the facility that promote understanding symptoms of COVID-19, and best practices of protecting oneself from COVID-19. BACKYARD: Covered outdoor area equipped with furniture. Following recommendations were made: -Appropriate signage to remind staff/client of cough etiquette and hand hygiene, etc (post in area for residents to see). Exit interview conducted. A copy of report was issued.the state’s words, verbatim · CDSS document, Sep 1, 2022

Allegation investigated: Staff not following resident's dietary plan. Resident's personal items are inaccessible. Staff neglected resident.

Licensing Program Analyst (LPA) Brian Balisi conducted a subsequent complaint investigation for the above allegations. Upon arrival LPA met with Lidia and explained the reason for the visit. During the course of the investigation, LPA conducted a physical plant tour 09/09/2021 as well as interviewed Administrator, staff and residents. LPA also gathered and reviewed facility documentation pertinent to the allegations. LPA also interviewed parties with knowledge of the situation. It was alleged that staff are not following resident's dietary plan. LPA interview with staff revealed that Resident 1 (R1) did not have a dietary plan ordered by a doctor or dietician, but they were diabetic. Staff ensured R1 consumed food items with little or no sugar and high protein. R1 was consistently offered fruits and vegetables , but they were not highly preferred by R1. LPA interview with the spouse of R1 revealed they never had concerns of the staff not offering a healthy and balanced diet for R1. (Continued on 9099-C) Unsubstantiated Continued from 9099 The spouse stated staff would express concern whenever the spouse visited and occasionally brought candy and fast food for R1. LPA records review revealed that there was no dietary plan on file for R1. Based on the information gathered during this and previous visits, the department does not have sufficient evidence to determine that staff are not following resident's dietary plan. Therefore, this allegation has been UNSUBSTANTIATED at this time. It was alleged that Resident's personal items are inaccessible. LPA interview with staff revealed that R1 was given (2) movable side tables , which R1 placed various items on that they liked to keep in reach, including their phone which was always attached to a 15 foot long charging cable. LPA's interview with spouse of R1 revealed R1 never expressed any concerns of any of their personal items being inaccessible and they also stated that whenever they would pay R1 a visit , they observed all of R1's personal items always within reach including R1's phone charger. Based on the information gathered during this and previous visits, the department does not have sufficient evidence to determine that Resident's personal items are inaccessible. Therefore, this allegation has been UNSUBSTANTIATED at this time. It was alleged that Staff neglected resident, LPA interview with the spouse of R1 revealed that R1 never expressed any concerns of not being serviced, or being checked on by staff.The spouse stated that R1 enjoyed their time at the facility , but as their health began to decline R1 had become more demanding. R1's spouse stated they had no issues with the quality of service the staff provided to R1. LPAs interview with Staff 1 (S1) , who was one of the main caregivers who interacted with R1, revealed that at the time R1 was in their care, there was only (2) residents total, R1 and Resident 2 (R2). R2 had dialysis appointments 3 days out of the week so the majority of the time, R1 had the full attention of S1. S1 stated that R1 had a routine of checking on R1 at least every hour, but R1 would constantly call for S1 and either needed assistance or R1 just wanted to have a conversation. LPAs interview with other parties with knowledge of the situation stated they believe there is a sufficient amount of staff to provide care for the residents and they do not have any immediate or potential concerns of being neglected by staff. Based on the information gathered during this and previous visits, the department does not have sufficient evidence to determine that Staff neglected resident. Therefore this allegation has been UNSUBSTANTIATED at this time. Exit interview conducted. Report issued and sent via email.the state’s words, verbatim · CDSS document, Oct 22, 2021 · control 29-AS-20201026173838

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Martha Guzman Chavez conducted an unannounced visit to Simi Hills Home Care Center, LLC to conduct a Required 1-Year Annual Inspection with focus on Infection Control. Last annual conducted was on 8-18-2019. LPA was greeted and screened at the door by staff Antonio Salazar. Administrator Lidia Medina and Angelica Medina arrived at the facility shortly after and were explained the reason for the visit. Entrance interview conducted. LPA toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. LPA along with Administrator Lidia, initiated a tour at 9:38am and the following was observed: There is a central entry point designated for universal screening for visitors by the entrance. At 10:27 am, Smoke detectors and Carbon Monoxide detector were tested and functioned properly. Fire extinguisher was observed to be fully charged on June 12, 2021. First-Aid Kit was observed to be complete. Medications are in the kitchen in a locked cabinet. Main temperature displayed by hallway and read at 74 degrees Fahrenheit for the facility. LPA conducted a file review for two (2) residents at facility. All required forms and pertinent documents were observed to be completed. OUTDOOR SPACE: LPA observed the backyard to have a covered outdoor area with a tables and chairs for resident use. There is one (1) gate on the side of the house that has a single latch and remains unlocked. KITCHEN: LPA observed the kitchen/dining area to be clean. Knives are stored in a locked cabinet under the kitchen sink. Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable and non-perishable food. -Continued on LIC 809c Continued from LIC 809 BEDROOMS: LPA observed the resident bedrooms, which were furnished appropriately. Observed inside each room was a bed with clean linens, a nightstand, and adequate lighting. RESTROOMS: LPA observed the restrooms to be clean, sanitary and in operating condition with grab bars and non-skid mats inside the shower. LPA observed signs posted in resident bathrooms and kitchen sink on washing hands and cough etiquette. Water temperature was checked in two (2) resident bathrooms and are in compliance at 105.8 degrees Fahrenheit for bathroom #1- and 106 degrees Fahrenheit for bathroom #2. LPA observed at least a 30-day supply of Personal Protection Equipment (PPE). The facility cleans the common areas at least twice daily. There are signs posted throughout the facility showing cough/sneeze etiquette and how to properly wash hands. If needed, the facility has the capacity to designate a single isolation room if the facility has a confirmed case of COVID-19. During plant tour, Administrator printed and posted CDSS PINs in an easily accessible area for both residents and visitors. Pursuant to Title 22, Division 6, facility observed to be compliant with regulation. No corrections needed at this time. Exit interview conducted. A copy of the report was provided via email.the state’s words, verbatim · CDSS document, Sep 9, 2021